Ask the expert: Should no- and low-volume providers be allowed to vote on medical staff matters?

The associate category is a non-voting category. It usually consists of new appointees to the medical staff who may not vote for one year while they “learn the system” at their new hospital. Some medical staffs feel that if you are a medical staff member you should be allowed to vote and therefore do not have this category at all.

In the case of low-volume and no-volume physicians, the decision on whether these practitioners should have a vote is a cultural decision of the medical staff. There is good rationale for either decision.

• In support of the decision that low-volume and no-volume practitioners should not have a vote:
  • Some medical staffs feel that they do not have a good understanding of the dynamics of the inpatient environment and should not be making decisions on how this works
  • Some feel that low-volume and no-volume practitioners are not subject to the same policies that they vote for and therefore have a skewed perspective on the burden on the practitioner that some of these decisions may make
• In support of the decision that low-volume and no-volume practitioners should have a vote:
  • Some feel that continued referrals from these practitioners are vital to the health of the hospital and support other practitioners that do the inpatient work
  • Some feel that if a vote is not given to these individuals, they may feel disrespected and take their referrals to a competing organization
  • Some feel that senior medical staff members who wish to provide outpatient care as they approach retirement have played vital roles in medical staff leadership and may wish to continue to do so

The voting issue is a cultural and strategic decision. These low-volume and no-volume physicians could be placed in the active category with a vote or in the associate category without a vote, whichever is more appropriate to the medical staff members concerned.

This week’s ask the expert was provided by Mary Hoppa, MD, MBA, CMSL, senior consultant with The Greeley Company, a division of HCPro, Inc. in Marblehead, MA